Economic Burden and Healthcare Resource Utilization Associated with Multi-Drug Resistant Acinetobacter baumannii: A Structured Review of the Literature

Abstract

Objective: Infections caused by multidrug resistant (MDR) Acinetobacter baumannii (ACB) are an increasing global problem. This review identifies and summarizes available research concerning resource utilization associated with MDR ACB, assesses strengths and weaknesses of the published research and identifies future research priorities. Methods: A structured review of the literature using MEDLINE enhanced by search of reference lists was conducted. Included articles reported on resource utilization or costs and described MDR ACB patients or compared cases to controls. Controls included patients with susceptible ACB, other organisms, or uninfected patients. Initial searches of the literature returned 204 potential citations for review. Title and abstract review excluded 171 articles, and full text review excluded 23 additional articles, leaving a total of 10 articles eligible for data abstraction and review. The full text of the 10 remaining articles was reviewed. Data on the characteristics of the studies and outcomes of interest were collected and organized into summary tables. All data were reviewed by a second reviewer. Results: Patients with MDR ACB had longer length of stay (LOS) than control groups across all studies, though findings were not always statistically significant. Within intensive care unit settings, LOS differences were significant in two of three studies. Hospital costs or charges were higher, sometimes significantly so, among patients with MDR ACB compared to controls. Conclusion: There was a consistent trend towards worse economic outcomes (longer LOS, higher costs) among patients with MDR ACB versus controls. Given the variety of study types and settings and the lack of multivariate analyses, there is considerable need for future studies.